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Psychiatric Interviewing E-Book

Psychiatric Interviewing E-Book

Shawn Christopher Shea


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 With time at a premium, today's clinicians must rapidly engage their patients while gathering an imposingly large amount of critical information. These clinicians appropriately worry that the "person" beneath the diagnoses will be lost in the shuffle of time constraints, data gathering, and the creation of the electronic health record. Psychiatric Interviewing: The Art of Understanding: A Practical Guide for Psychiatrists, Psychologists, Counselors, Social Workers, Nurses, and other Mental Health Professionals, 3rd Edition tackles these problems head-on, providing flexible and practical solutions for gathering critical information while always attending to the concerns and unique needs of the patient.

Within the text, Dr. Shea deftly integrates interviewing techniques from a variety of professional disciplines from psychiatry to clinical psychology, social work, and counseling providing a broad scope of theoretical foundation. Written in the same refreshing, informal writing style that made the first two editions best sellers, the text provides a compelling introduction to all of the core interviewing skills from conveying empathy, effectively utilizing open-ended questions, and forging a powerful therapeutic alliance to sensitively structuring the interview while understanding nonverbal communication at a sophisticated level. Updated to the DSM-5, the text also illustrates how to arrive at a differential diagnosis in a humanistic, caring fashion with the patient treated as a person, not just another case.

Whether the reader is a psychiatric resident or a graduate student in clinical psychology, social work, counseling or psychiatric nursing, the updated third edition is designed to prepare the trainee to function effectively in the hectic worlds of community mental health centers, inpatient units, emergency rooms, and university counseling centers. To do so, the pages are filled with sample questions and examples of interviewing dialogue that bring to life methods for sensitively exploring difficult topics such as domestic violence, drug abuse, incest, antisocial behavior, and taking a sexual history as well as performing complex processes such as the mental status. The expanded chapter on suicide assessment includes an introduction to the internationally acclaimed interviewing strategy for uncovering suicidal ideation, the Chronological Assessment of Suicide Events (CASE Approach). Dr. Shea, the creator of the CASE Approach, then illustrates its techniques in a compelling video demonstrating its effective use in an interview involving a complex presentation of suicidal planning and intent

.A key aspect of this text is its unique appeal to both novice and experienced clinicians. It is designed to grow with the reader as they progress through their graduate training, while providing a reference that the reader will pull off the shelf many times in their subsequent career as a mental health professional. Perhaps the most unique aspect in this regard is the addition of five complete chapters on Advanced and Specialized Interviewing (which comprise Part IV of the book) which appear as bonus chapters in the accompanying e-book without any additional cost to the reader. With over 310 pages, this web-based bonus section provides the reader with essentially two books for the price of one, acquiring not only the expanded core textbook but a set of independent monographs on specialized skill sets that the reader and/or faculty can add to their curriculum as they deem fit.

Table of Contents

Section Title Page Action Price
Front Cover cover
Inside Front Cover ifc1
Praise for Psychiatric Interviewing, 3rd Edition i
Advance Praise for the Third Edition i
Praise for Previous Editions of Psychiatric Interviewing: the Art of Understanding iv
Praise From the Reviewers iv
Praise From the Experts and Faculty for Previous Editions v
Psychiatric Interviewing vii
Copyright Page x
Dedication xi
Foreword xii
Foreword to the 2nd Edition xiv
Preface xvi
A Few Stylistic Notes From the Author xxi
Acknowledgments xxii
Table Of Contents xxv
Video Table of Contents xxvii
I Clinical Interviewing: The Principles Behind the Art 1
1 The Delicate Dance 3
In Search of a Definition 4
A Bit of Interviewing Examined and the Discovery of a Map 4
Person-Centered Interviewing 8
The Next Step 9
Creating the Therapeutic Alliance 10
First Things First: The Difference Between Engagement and Blending 10
Using Blending to Gauge the Degree of Engagement 10
Conveying Empathy: Traps, Strategies, and Solutions 14
The Empathy Cycle 14
First Phase of the Empathy Cycle: Patient Expresses a Feeling 15
Second Phase of the Empathy Cycle: Clinician Recognizes the Patient’s Feelings 16
Third Phase of the Empathy Cycle: Clinician Conveys Recognition of the Patient’s Feelings 17
Strategic Empathy 17
Interpersonal Stance 18
Empathic Valence 19
Valence of Implied Certainty 19
Valence of Intuited Attribution 21
Basic Guideposts for Effectively Using Strategic Empathy 23
Three Examples of Using Strategic Empathy to Transform Difficult Moments 23
1: The Paranoid Spiral 23
2: Transforming Anger with Defusing Statements 27
3: Shoring Up a Young Empathic Bond with Paraphrasing Statements 29
Generic Paraphrases. 29
The Metaphorical Paraphrase. 30
Frequency, Timing, and Length of Effective Empathic Statements 31
Fourth Phase of the Empathy Cycle: Patient Accurately Perceives the Clinician’s Empathic Statement 33
Fifth Phase of the Empathy Cycle: Patient Communicates an Appropriate Acceptance of the Clinician’s Empathic Statement 33
References 34
2 Beyond Empathy 37
The Person Before the Letters 37
Inducement of a Safe Relationship 38
Clinician Genuineness 41
Clinician Expertise 44
Collaborative Interviewing Models: New Tools for Enhancing Engagement 50
Solution-Focused Goal Setting 51
The Miracle Question 52
Concluding Statements 54
References 54
3 The Dynamic Structure of the Interview 57
Introduction: Phase 1 58
Creating a Safe Environment 58
Addressing Confidentiality 64
Opening: Phase 2 66
Patient’s Perspective and Conscious Agenda 68
Assessment of the Patient’s Immediate Mental State 72
Clinician’s Perspective of the Patient’s Problems and the Patient’s Unconscious Goals 73
Evaluation of the Interview Itself 77
Degree of Openness Continuum (DOC): Open-Ended Questions, Gentle Commands, Swing Questions, and the Power of Language 78
In Search of an Answer: What Is an Open-Ended Question? 78
Open-Ended Verbalizations 79
Closed-Ended Verbalizations 81
Variable Verbalizations 81
Transforming Shut-Down Interviews 83
Characteristics of Shut-Down Interviews 83
Unlocking Shut-Down Interviews 85
Transforming Wandering Interviews 90
Characteristics of Wandering Interviews 90
Transforming Rehearsed Interviews 95
Characteristics of Rehearsed Interviews 95
Breaking Through a Rehearsed Interview 96
Body of the Interview: Phase 3 98
The Gathering of the Database 98
Conveying Expertise, the Generation of Hope, and the Return Visit 100
Closing of the Interview: Phase 4 101
Termination of the Interview: Phase 5 108
Conclusion 108
References 109
4 Facilics 113
Sensitively Creating Conversational Interviews 113
Secrets from Everyday Conversation 113
A Solution to the Dilemma 115
Introduction to the Practical Application of Facilics 116
Part I: Learning How to Tag the Flow of the Interview – What Topics, When? 116
Descriptions and Characteristics of Facilic Regions 116
Content Regions 116
Process Regions 119
1. Free Facilitation Regions 120
2. Transformational Regions 121
3. Psychodynamic Regions 122
The Scouting Region: A Unique Combination of Content and Process 123
Part II: Practical Tips for Applying Facilic Principles to the Exploration of Regions 124
Using Time Effectively 124
The Core Conundrum: Well-Timed Tracking Versus Poorly Timed Tracking 124
A Basic Paradigm for Successfully Structuring an Initial Interview 125
Recognizing and Transforming Two Structuring Gremlins 126
1. Overly Lengthy Scouting Region: The “Five-Minute Fix” 126
2. The Dead Zone: Two Errors in One 127
The Eight Golden Rules for Structuring Effectively 128
Exploring Content Regions in a Sensitive Fashion 129
Part III: Facilic Gating – The Fine Art of Making Graceful Transitions 132
Gates: The Pathways of Conversational Flow 132
Spontaneous Gates 132
Natural Gates 134
Manufactured “Gates” 136
Referred Gates 139
Phantom Gates 142
Implied Gates 143
Miscellaneous Gates 144
Introduced Gate 145
Observed Gate 145
The Finishing Touches: Summarizing the Principles of Facilics 145
Concluding Comments 147
References 147
5 Validity Techniques for Exploring Sensitive Material and Uncovering the Truth 149
Understanding the Challenge of Exploring Sensitive Material 149
Validity Techniques: Keys to Eliciting Sensitive Material 152
Cluster One: Techniques for Improving Generalized Recall 152
The Dilemma 152
Anchor Questions 153
Anchor Questions (Focused Upon Time) 153
Anchor Questions (Focused on Location) 154
Tagging Questions 155
Exaggeration 155
Cluster Two: Validity Techniques for Avoiding Miscommunication 157
Defining Technical Terms 157
Clarifying Norms 157
Cluster Three: Validity Techniques for Raising a Sensitive or Taboo Topic 159
Normalization 159
Shame Attenuation 160
Shame Attenuation Used to Bridge From Pain or Situational Stress 160
Shame Attenuation Used to Uncover Aggressive, Unethical, and Antisocial Behaviors 161
Induction to Bragging 164
Cluster Four: Validity Techniques for Exploring a Sensitive Topic Once It Has Been Raised 165
Behavioral Incident 165
Interviewer 1 166
Interviewer 2 166
Helping a Patient to Describe an Episode of Intimate Partner Violence (IPV) 168
Limitations of Behavioral Incidents 169
Gentle Assumption 170
Denial of the Specific 171
Catch-All Question 173
Symptom Amplification 173
Validity Technique Combinations 174
Miscellaneous Tips for Specific Situations Where Validity Is a Concern 176
Malingering 176
Gauging Motivation 178
Taking a Sexual History 180
Interview Illustrating the Use of Various Validity Techniques 181
References 185
6 Understanding the Person Beneath the Diagnosis 187
Introductory Illustration: The Person Beneath the Diagnosis 187
Part I: Phenomena That Hinder the Understanding of the Person 192
Parataxic Distortion 192
Further Problems With Inaccuracy: The Issue of Reliability 194
Part II: Phenomena That Deepen the Understanding of the Person Beneath the Diagnosis 196
Sullivan’s Interpersonal Perspective Revisited 196
Phenomenological Inquiry 200
The Search for Wellness: Patient Strengths, Skills, and Interests 202
Exploring Component 203
Strengths of Knowledge: 204
Strengths of Courage: 204
Strengths of Humanity: 204
Strengths of Justice: 204
Strengths of Temperance: 204
Strengths of Transcendence: 204
Exploring Component 205
Creative Skills: 206
Task Related: 206
Interpersonal Skills: 206
Athletic Skills: 206
Manual Dexterity: 206
Specific Career Training: 207
Exploring Component 209
Part III: Understanding Cultural Diversity – Its Vital Role in the Initial Interview 211
Misperceptions Related to Cultural Biases: Impact on the Initial Therapeutic Alliance 212
Culture Impacting Directly on Treatment Planning in the Initial Interview 214
References 217
7 Assessment Perspectives and the Human Matrix 221
Clinical Presentation: the Initial Interview 224
The Diagnostic Perspective of the DSM and ICD Systems 225
The Healing Power of Differential Diagnosis 225
Limitations of Formal Diagnostic Systems Such as the DSM and ICD 227
The Loss of Multiaxial Formulation: a Historical Footnote 228
Major Psychiatric Disorders (Other Than Personality Disorders) 230
Personality Disorders 232
Non-Psychiatric Medical Conditions 233
Psychosocial Context and Stressors 234
Level of Current Functioning and Impairment 234
Clinical Application of the DSM-5 235
Matrix Treatment Planning 238
Introduction 238
Basic Paradigm and History of the Biopsychosocial Treatment Planning Model 239
A Revitalizing Change in Language 245
Matrix Treatment Planning: General Clinical Principles and Specific Applications to Debbie in the Initial Interview 247
First Wing of the Matrix: Biologic 247
Biological Intra-Wing Interventions 247
Biological Inter-Wing Interventions 248
II The Interview and Psychopathology: From Differential Diagnosis to Understanding 335
9 Mood Disorders 337
Introduction 337
Diagnostic Systems: There Has Never Been a Perfect One and There Never Will Be 339
The Nature of the Dilemma for Front-Line Clinicians 339
Validity Versus Reliability 339
Construct Validity, Face Validity, and Descriptive Essence 340
Categorical Diagnostic Systems Versus Dimensional Diagnostic Systems 341
Categorical Diagnostic Systems 341
Dimensional Diagnostic Systems 342
A Pivotal Step Forward in the DSM-5 342
First Steps in the Differential Diagnosis of Mood Disorders 343
Clinical Presentations and Discussions 346
Clinical Presentation 346
Discussion of Mr. Evans 347
The Painful World of Anhedonia: Its Role in Diagnosis 347
Uncovering the Neurovegetative Symptoms of Depression 348
What Are the Neurovegetative Symptoms of Depression? 348
Tips for Exploring Early Morning Awakening and Other Sleep Disturbances 349
Sensitively Asking Patients About Libido 350
Gracefully Weaving the Neurovegetative Symptoms Into the Interview 351
The Concept of Melancholia 352
Anxiety: Another Important Dimensional Specifier 353
The Role of Substance Abuse in the Differential Diagnoses of Depression 353
Important Data Points When Taking a Past Psychiatric History 354
Spotting Bipolar I Disorder: Traps and Nuances 356
Bipolar I Disorder 358
Classic Euphoric Mania 358
Psychotic Process in Mania 361
The Importance of Family Members and Collaborative Sources When Delineating Mania 361
Cognitive Deficits in Mania 362
Differential Diagnosis on Mr. Evans and Summary of Key Interviewing Tips 363
Clinical Presentation 364
Discussion of Danny Ramirez 365
Bipolar I Disorder, Mixed Presentation 365
History Repeats Itself: An Evolving Diagnosis 365
A Practical Solution From the DSM-5 367
“Dysphoric Mania”: One Type of Mixed Bipolar Disorder 368
Differentiating a Dysphoric Mania From an Agitated Depression 368
Three Practical Tips for Spotting a Dysphoric Mania. 371
Historical Tip-Offs That Raise the Suspicion of Mixed Bipolar States in General 374
Over-Diagnosing Bipolar Disorder: A Serious Diagnostic Error 375
Bipolar II Disorder 376
Substance/Medication-Induced Bipolar and Related Disorder 378
Recognizing Suicidal Ideation Unleashed During Partial Manic Responses to a Medication 380
Cyclothymic Disorder and Rapid Cycling 381
Differential Diagnosis on Danny Ramirez and Summary of Key Interviewing Tips 382
Clinical Presentation 385
Discussion of Mr. Whitstone 386
Patient Hesitancies to Admit to Depression and How to Transform Them 386
Cross-Cultural Issues in Recognizing Depression 387
Problems With Concentration and Cognitive Functioning in Depression 388
Spotting Atypical Depression 388
Psychotic Process in Depression 391
Ruling Out Non-Psychiatric Biological Causes of Depression 391
Differential Diagnosis on Mr. Whitstone and Summary of Key Interviewing Tips 393
Clinical Presentation 394
Discussion of Ms. Wilkins 394
The Need to Determine the Persistence of Depressive Symptoms and How to Do It 394
Red Herrings: Disorders That Mimic Major Depressions 396
Tips for Delineating an Accurate History of the Presenting Disorder 397
Ruling Out Peripartum Depressions, Grief, Adjustment Disorders, and V-Codes 399
Differential Diagnosis on Ms. Wilkins and Summary of Key Interviewing Tips 400
Clinical Presentation 402
Discussion of Mr. Collier 402
Techniques for Eliciting a Family History 402
Difficulties in Taking a Family History and How to Transform Them 403
Cross-Cultural Sensitivity When Taking a Family History 405
Family History as a Reflection of Family Dynamics 406
Differential Diagnosis on Mr. Collier and Summary of Key Interviewing Tips 406
References 409
10 Interviewing Techniques for Understanding the Person Beneath the Mood Disorder 413
Introduction 413
The Pain Beneath Depression 414
Fields of Interaction 414
The Biological Wing of the Matrix 414
The Psychological Wing of the Matrix 417
1. Depressive Changes in How the World Is Perceived 417
The Window Shade Response 418
2. Cognitive Changes Caused by Depression 419
Changes in the Flow of Thought and Ideational Caging 419
Cognitive Distortions as Conceptualized by Aaron Beck 420
First Distortion in Beck’s Triad: Negative View of the World 421
Second Distortion in Beck’s Triad: Negative Self-Concept 421
Third Distortion in Beck’s Triad: Negative View of the Future 421
3. Alterations in Thought Content Found in Depression 422
Depressive Loneliness 422
Depressive Guilt and Self-Loathing 422
Depressive Helplessness 423
Depressive Hopelessness 423
4. Psychodynamic Defenses and Their Role in Depression 423
The Dyadic Wing of the Matrix 425
The Impact of the Patient’s Depression on the Interviewer 426
How a Clinician’s Behaviors Can Submerge a Depression From View 427
Effectively Addressing Tearfulness 427
The Familial and Societal Wing of the Matrix 428
An Illustration of the Insidious Impact of Depression on a Family 429
Addressing the Pain of Family Members 430
Uncovering Potentially Damaging Family Impacts on the Patient 430
The Impact of Depression on Societal and Cultural Systems 431
Cultural Impacts on the Patient’s Depression 432
The Wing of the Matrix Encompassing Worldview and Spirituality 433
References 435
11 Psychotic Disorders 437
Introduction 437
The Differential Diagnosis of Psychotic States 438
Clinical Presentations and Discussions 441
Clinical Presentation 441
Discussion of Mr. Williams 441
Phenomenology of Visual Hallucinations and Illusions: Their Diagnostic Implications 441
Recognizing Psychotic Process Induced by Alcohol Withdrawal 443
Recognizing Psychotic Process Induced by Street Drugs 445
Recognizing Medication-Induced Psychosis 447
Effectively Interviewing and Collaborating With Law Enforcement Officers 448
Differential Diagnosis on Mr. Williams and Summary of Key Interviewing Tips 449
Clinical Presentation 450
Discussion of Mr. Walker 451
Spotting Disturbances of Affect as Seen in Schizophrenia 451
Diagnostic Significance of the Presence of Delusions: Delineating Schizophrenia From Delusional Disorders 452
Negative (Deficit) Symptoms of Schizophrenia 453
The Importance of Family Members in Uncovering Psychotic Process 453
Differential Diagnosis Between Schizophrenia and Mood Disorders With Psychotic Features 454
Schizoaffective Disorder and the Schizo–Bipolar Continuum 456
Differential Diagnosis on Mr. Walker and Summary of Key Interviewing Tips 459
Clinical Presentation 460
Discussion of Ms. Hastings 460
Types of Delusional Disorders 460
Paranoid Delusions: Techniques for Uncovering Potential Dangerousness 464
Delusions in the Elderly and Paraphrenia 466
Differential Diagnosis on Ms. Hastings and Summary of Key Interviewing Tips 468
Clinical Presentation 469
Discussion of Ms. Fay 469
The Life Cycle of a Psychosis 469
Delusional Mood 470
Delusional Perception 472
The Emergence of Concrete Delusional Ideation 472
Soft Signs of Psychosis: How to Spot Hidden Psychotic Process 473
Helping Patients to Share Delusional Material 474
Tapping Intense Affect 474
Tapping Odd Language, Illogical Thought, and Idiosyncratic Phrasing 474
Indirect Techniques for Exploring Delusional Material 474
Examples 475
Illustrative Dialogue 475
How to Respond When a Delusional Patient Asks, “Do You Believe Me?” 475
Hallucinations and Other “Hard Signs of Psychosis” in the Normal Population 477
Auditory and Visual Hallucinations in the Normal Population 477
Cultural Competence: Its Importance in Distinguishing True Psychotic Symptoms From Culturally Accepted Behaviors 478
The Interface Between Cultural Phenomena and the Life Cycle of a Psychosis 479
Back to Ms. Fay: An Illustration of How to Tap a Piece of Illogical Thought for Underlying Delusional Material 480
Differential Diagnosis on Ms. Fay and Summary of Key Interviewing Tips 481
Clinical Presentation 484
Discussion of Mr. Lawrence 484
A Deadly Trap: Missing Deliria in Patients With Illnesses Such as Schizophrenia 485
Practical Tips for Spotting a Delirium: The Nature of the Beast 486
Four Cognitive Tests Useful for Recognizing a Subtle Delirium 488
Differential Diagnosis on Mr. Lawrence and Summary of Key Interviewing Tips 490
Clinical Presentation 492
Discussion of Kate 492
Spotting Non-Delirial Psychoses Caused by Underlying Medical Conditions 492
When to Refer for a Physical Exam and What to Do If You Can Perform One 494
Differential Diagnosis on Kate and Summary of Key Interviewing Tips 495
Clinical Presentation 497
Discussion of Ms. Flagstone 497
“Micropsychotic Episodes” Seen in People Coping With Personality Disorders 497
Psychotic Processes With a Rapid Onset/Offset 498
Differential Diagnosis on Ms. Flagstone and Summary of Key Interviewing Tips 499
Recognizing Psychotic Process Triggered by Seizure Disorders 499
References 502
12 Interviewing Techniques for Understanding the Person Beneath the Psychosis 507
The Pain Beneath Psychotic Process 508
Fields of Interaction 508
I. The Biological Wing of the Matrix 508
Sleep Disturbances in Psychosis 508
Psychotic Disruption of the “Sensation of the Physical Boundaries of the Body” and the Concept of a “Porous Ego” 508
Schneiderian First-Rank Symptoms of Psychosis 509
Exploring Somatic Passivity and “Made Feelings”: The World of the Porous Ego 510
Thought Withdrawal and Thought Insertion 512
Thought Broadcasting (Unintentional and Intentional) 513
Spotting Medication-Induced Akathisia 514
Establishing an Alliance With a Patient Experiencing Catatonia 517
II. The Psychological Wing of the Matrix 518
Auditory Hallucinations: Their Nature, Phenomenology, and Exploration 518
The Directional Location of Auditory Hallucinations 519
The Reality of Auditory Hallucinations to the Patient 521
Distinction Between Auditory Hallucinations and Auditory Illusions 521
The Uniqueness of Auditory Hallucinations 522
Schneiderian Symptoms Related to Auditory Hallucinations 522
The Relationship Between the Patient and the Patient’s Voices 522
Uncovering and Sensitively Exploring Auditory Hallucinations 524
Sensitively Raising the Topic of Auditory Hallucinations 525
Sensitively Exploring the Phenomenology of Auditory Hallucinations Once Raised 526
Illustrative Transcript of a Clinician Exploring Auditory Hallucinations 527
Exploring Command Hallucinations 528
Exploring the Content of Command Hallucinations 530
Exploring the Auditory Quality of Command Hallucinations 530
Exploring the Degree to Which a Patient Feels Able to Resist a Command Hallucination 531
Exploring the Emotional Impact of Command Hallucinations on a Patient 531
Psychotic Disruptions in Cognition, Logic, and Communication 532
How to Safely Interact With an Illogical, Agitated Psychotic Patient 533
Unobtrusively Screening for Paranoid Process, Delusions, and Other Psychotic Process 534
Understanding the Demoralization and Self-Denigration Spurred by Psychotic Process 537
III. The Dyadic Wing of the Matrix 538
Uncovering Social Withdrawal and Recognizing Social Inappropriateness 538
The Impact of Psychotic Process on the Interviewer’s Emotions and Behaviors 539
The Impact of the Interviewer’s Behaviors on Psychotic Process 540
IV. The Familial, Cultural, and Societal Wing of the Matrix 541
Understanding the Exquisite Pain of Family Members 541
Practical Techniques for Engaging Family Members in the Initial Interview 543
Opening the Conversation in an Initial Encounter With a Family Member 543
Tips for Initial Interviews With Family Members on Inpatient Units 545
Talking With Patients About Involving Their Family Members in Assessment and Treatment 546
Cultural and Societal Impacts on Psychotic Process 548
Encountering Culture-Bound Syndromes and Behaviors 548
Missing Culturally Specific Psychotic Process 548
Mistaking Culturally Normal Phenomena for Psychotic Process Redux 550
The Community Mental Health Center as a Subculture 551
Language and Culture: Potential Roadblocks When Uncovering Psychotic Process 552
V. The Wing of the Matrix Encompassing Worldview and Spirituality 553
Psychotic Destruction of the Patient’s Religious Worldview 553
The Personalized Meaning of Psychotic Symptoms to Patients 554
References 555
13 Personality Disorders 559
Introduction 559
The Mystery of Personality Disorders Revealed: Core Principles and Definitions 560
In Search of a Definition 560
The Gestalt of Personality Dysfunction 560
DSM-5 Definitions of a Personality Disorder 563
Personality Disorders as Reflections of the Social History 563
The Nature of Personality Diagnoses: Abuses and Uses 565
A Cautionary Note 565
The Beneficial Uses of Personality Diagnoses 566
A Useful Metaphor 570
The Etiology of Personality Disorders 571
References 573
14 Personality Disorders 575
Introduction 575
Section I: A Survey of the DSM-5 Personality Disorders 576
Goals and Limitations of the Survey 576
1. Anxiety-Prone Disorders 577
Obsessive–Compulsive Personality Disorder 577
Dependent Personality Disorder 578
Avoidant Personality Disorder 578
2. Poorly Empathic Disorders 579
Schizoid Personality Disorder 579
Antisocial Personality Disorder 580
Histrionic Personality Disorder 581
Narcissistic Personality Disorder 582
3. Psychotic-Prone Disorders 583
Borderline Personality Disorder 583
Schizotypal Personality Disorder 584
Paranoid Personality Disorder 585
Section II: Common Problems Encountered When Diagnosing Personality Disorders 586
Premature Diagnosis: “Label Slapping” 586
Mistaking Behaviors Shown in the Interview as Personality Traits 586
Problems With Countertransference 587
Inappropriate Hesitation to Make a Personality Diagnosis 587
Section III: Using the DSM-5 to Arrive at a Personality Diagnosis 589
Step 590
Passively Scouting for Clues to Personality Dysfunction 590
Signal Signs 590
Signal Symptoms 594
Actively Limiting the Diagnostic Field With Probe Questions 596
Illustration of a Clinician Limiting the Field of Diagnostic Possibilities 599
Step 602
Illustration of a Clinician Expanding the Diagnostic Criteria of a Specific Diagnosis 603
Verifying the Validity of Patient-Reported Diagnostic Traits 607
Enhancing Validity by Maintaining Engagement 607
Techniques for Verifying Historical Persistency 608
Techniques for Ruling Out State Dependency 608
Verifying Pathological Severity 609
Tapping for Epiphenomena 610
Section IV: Future Diagnostic Systems of Personality Dysfunction and the Usefulness of Dimensionality Today 613
Dimensionality: A Note of Caution 613
The Power of Dimensionality in the Initial Interview 614
Entrance Questions for Exploring Personality Traits 616
Differential Diagnosis of Personality Disorders: A Glimpse Into the Future 620
Building Upon the DSM-5 Categorical System 620
Conclusion 622
References 623
15 Understanding and Effectively Engaging People With Difficult Personality Disorders 627
Introduction to Object Relations and Self Psychology 627
Goals of This Chapter and Core Definitions 629
Defining Object Relations and Self Psychology 630
What Propels the Development of the Self? 632
The Four Developmental Stages of the Self and Their Clinical Applications 633
Developmental Stage 633
Developmental Stage 635
Winnicott, Merger Objects, and Transitional Objects 635
Signal Signs Arising From Merger Dynamics 636
Signal Symptoms Arising From Merger Dynamics 638
Enhancing Engagement as Related to Merger Objects 639
Kernberg, Splitting, and the Move Towards Mobility 640
Signal Signs Arising From Splitting Defenses 641
Signal Symptoms Arising From Splitting Defenses 643
Enhancing Engagement as Related to Splitting Defenses 644
Developmental Stage 644
Kohut, the Bipolar Self, and the Search for Independent Functioning 644
Signal Signs Arising From the Psychodynamics of the Bipolar Self 650
Signal Symptoms Arising From the Psychodynamics of the Bipolar Self 651
Enhancing Engagement Via an Understanding of the Bipolar Self 652
Complementary Shifts 652
Countertransference: Short-Circuiting a Clinical Gremlin 655
Accepting Idealization 656
Developmental Stage 657
Concluding Comments: on the Utility of Mirrors 658
References 659
III Mastering Complex Interviewing Tasks Demanded in Everyday Clinical Practice 661
16 The Mental Status 663
Introduction 663
The Impact Status 664
The Mental Status 665
General Characteristics of the Mental Status: What Is It? 665
Documenting the Mental Status 666
Components of the Mental Status 668
1. Appearance and Behavior 668
2. Speech Characteristics and Thought Process 670
3. Thought Content 673
Ruminations 673
Obsessions 673
Compulsions 673
Delusions 674
Thought Concerning Dangerousness to Self and Others 674
4. Perception 675
5. Mood and Affect 676
6. Sensorium, Cognitive Functioning, and Insight 678
References 681
17 Exploring Suicidal Ideation 683
Introduction 683
Section 1: Risk Factors, Warning Signs, and Protective Factors: Their Role in the Clinical Formulation of Risk 684
Important Distinctions and Critical Limitations 684
Risk Factors Versus Risk Predictors (Warning Signs) 684
Static Versus Dynamic Risk Factors 686
Protective Factors 687
Uncovering and Weighing Risk Factors and Warning Signs: The State of the Art 688
Clinical Illustrations 688
Clinical Illustration 688
Clinical Illustration 700
Risk Factors and Warning Signs: Summary and Effective Utilization 705
Useful Mnemonics 705
Loose Ends and a New Mnemonic 706
Differentiating Between Concerns of Chronic Suicide Risk Versus More Immediate Risk 707
The Tetrad of Lethality: Four Common Indicators That Hospitalization May Be Required 707
Section 2: the Elicitation of Suicidal Ideation, Planning, Behaviors, and Intent 710
1. Before the Interview Begins: Secrets, Countertransference, and Problematic Myths 710
2. The Importance of Uncovering Suicidal Ideation and Why It Is Hard to Do So 713
Roadblocks to Sharing Suicidal Ideation 713
Reflected Intent: One of the Master Keys to Unlocking Real Intent 715
Pitfalls of an Incomplete Elicitation of Suicidal Ideation 716
Premature Crisis Resolution 716
Lost Data for the Receiving Clinician 717
The Power of a Thorough Elicitation of Suicidal Ideation, Behavior, and Intent to Save a Life 717
The Issue of Credibility 717
Reaching for Life 718
3. Setting the Platform for the Suicide Inquiry 718
The “Elicitation of Suicidal Ideation Triad” 718
Step 1 of the Elicitation Triad: Enhancing Engagement With a Potentially Suicidal Patient 719
Step 2 of the Elicitation Triad: Helping the Potentially Suicidal Patient to Share Highly Charged Emotional States 719
Three Gateways to Suicidal Ideation 719
Step 3 of the Elicitation Triad: The Patient Hints at Suicide or Raises the Topic Spontaneously 721
4. Eliciting Suicidal Ideation, Planning, and Intent Using the Chronological Assessment of Suicide Events (CASE Approach) 722
Background, Rationale, and Limitations 722
The Question of Validity: Its Central Role in the CASE Approach 724
Two Validity Techniques for Sensitively Raising the Topic of Suicide 726
Normalization 726
Shame Attenuation 726
A Note on Word Choice: “Killing Yourself” Versus “Committing Suicide” 727
Five Validity Techniques Used to Explore the Extent of Suicidal Ideation 728
Behavioral Incident 728
Gentle Assumption 728
Denial of the Specific 729
Catch-All Question 730
Symptom Amplification 730
The Macrostructure of the CASE Approach: Avoiding Errors of Omission 731
The Microstructure of the CASE Approach: Exploring the Four Specific Timeframes 732
Step 1: The Exploration of Presenting Suicide Events 732
The Concept of Creating a Verbal Video 735
More Tips on Making a Verbal Video With Behavioral Incidents 737
Uncovering the Patient’s Apparent and Not-so-Apparent Motivations for Suicide 739
Clinical Illustration of Step 1: Exploring the Region of Presenting Suicide Events 740
Step 2: The Exploration of Recent Suicide Events 742
Clinical Illustration of Step 2: Exploring the Region of Recent Events 746
Step 3: The Exploration of Past Suicide Events 749
Clinical Illustration of Step 3: Exploring the Region of Past Events 750
Step 4: The Exploration of Immediate Suicide Events 752
Clinical Illustration of Step 4: Exploring the Region of Immediate Events 755
Concluding Comments 758
References 758
18 Exploring Violent and Homicidal Ideation 763
Introduction 763
Background 763
Characterizing Violence: Three Practical Domains for Clinicians 764
The Organization of the Chapter and the Role of Structured Risk Assessments 766
Part 1: Risk Factors for Violence 767
Past Violence 767
Sex, Age, and Environment 767
Presence of Psychiatric Disorders 768
Other Factors Suggested by the HCR-20 768
Part 2: Clinical Formulation of Risk – the Tetrad of Lethality 769
1. Patients Presenting With a Recent Violent Episode 769
2. Patients Presenting With Dangerous Psychotic Process 770
Command Hallucinations, Alien Control, and Hyper-Religiosity 771
Uncovering Paranoid Process 772
Complexities of Spotting Individuals Contemplating Mass Murder and Other Paranoid-Induced Violence 772
3. Indication From the Interview That the Patient Intends to Engage in Violence 776
4. The Patient Is Lying and Collaborative Evidence Suggests Intended Violence 776
A Few Caveats Regarding Domestic Violence 776
Part 3: the Art of Eliciting Violent and Homicidal Ideation 778
Setting the Stage 778
Chronological Assessment of Dangerous Events (the CADE Approach) 779
Presenting Event 779
Exploration of Recent Violent Events 780
Elicitation of Past Violent Events 785
Elicitation of Immediate Violent or Homicidal Ideation 786
Conclusion 787
Transitional Directions to Part IV: Advanced Interviewing and Specialized Topics 788
References 788
IV Specialized Topics and Advanced Interviewing 791
To the Reader 792
Chapters 792
Appendices and Glossary 792
19 Transforming Anger, Confrontation, and Other Points of Disengagement e3
Introduction e3
Part 1: Points of Disengagement – Core Definitions e7
The Nature of the Beast e7
Points of Disengagement: Type 1 – Moments of Angry Disengagement (MADS) e7
The Family of MADS: Three Siblings e7
1. Confrontational Disagreements e7
Deconstructing Disagreement: The Significance of a Fallen Log Upon a Road e7
Not All Disagreements Are Bad e8
2. Oppositional Behaviors e10
3. Passive-Aggressive Attitudes e11
Points of Disengagement: Type 2 – Potentially Disengaging Questions (PDQs) e13
Part 2: Points of Disengagement – Developing A Contemporary Language for Their Navigation e13
Clinical Illustration of a Disengagement Point e13
Recognizing the Surface Structure of MADs and PDQs e16
Recognizing the Underground Structure of MADS and PDQs: Finding the Person Beneath the Anger e18
Learning to Move With MADs and PDQs: The “Agreement Continuum” e21
Three Specific Approaches for Transforming MADs and PDQs e26
1. Content Responses to Disengagement Points e26
2. Process Responses to Disengagement Points e28
Type 1 Process Response: Patient Asked to Look at the Interview Process and His or Her Behaviors in the Interview e29
Type 2 Process Response: Patient Asked to Look at His or Her Affect, Thoughts, Feelings, or Concerns e30
Type 3 Process Response: Clinician Shares Thoughts or Feelings Generated by the Patient’s Behavior in the Interview e32
Advantages of Process Responses to MADS and PDQs e32
Clinical Illustration of Process Responses to a PDQ e32
Process Responses Versus Content Responses in the Initial Interview: Which One and Why e34
3. Sidetracking Disengagement Points e35
Our Transformational Language and Principles at Work: A Return Visit to Our Clinical Illustration e36
Part 3: Effectively Navigating Common MADs and PDQs e42
Disengagement Points Challenging the Clinician’s Competence e42
Handling Competency Questions Concerning a Trainee’s Lack of Experience e46
PDQs That Attempt to Gain Personal Information About the Clinician e48
Patient Requests: Yet Another Commonly Encountered PDQ e51
Transforming Awkward Situations Encountered With Psychotic Patients e52
Situational Roadblocks: The Unwilling Patient and Involuntary Commitments e55
Transforming Overt Hostility From Family Members e60
References e65
20 Culturally Adaptive Interviewing e67
Introduction: A Reason to Be e67
Part 1: Definitions, Attitudes, and Goals – in Search of Culturally Adaptive Interviewing e70
Basic Definitions: Race, Ethnicity, and Culture e70
Culture e70
Race e71
Ethnicity e71
Definition of “Cultural Competency”: More Complicated Than It Looks e72
Towards a Third Culture e74
Culturally Adaptive Interviewing e76
Part 2: the Mystery of Cultural Identity – Unpacking Assumptions e77
Things Are Not Exactly What They Seem: Intersectionality and Prioritizing Cultural Identities e77
Intersectionality e77
Prioritizing Cultural Identities: A Framework for Simplifying the Complex e78
Clinical Illustration of the Impact of Prioritizing Cultural Identities e79
Part 3: Developing and Utilizing Cultural Literacy to Engage Patients and to Better Understand the Complexity of Their Problems e81
Using Cultural Literacy to Enhance Engagement e81
Acquired and Discovered Cultural Literacy e81
Acquired Cultural Literacy e81
Discovered Cultural Literacy e85
Using Cultural Literacy Effectively: Some Clinical Illustrations e86
The Story of Marin e88
Cultural Literacy as a Guidepost for Therapeutic Exploration: Three Important Gateways e91
Gateway e91
Gateway e94
Gateway e96
Basic Principles e96
Core Definitions e101
Heterosexual. e101
Lesbian. e101
Gay. e101
Bisexual. e101
Cross-Dresser or Transvestite. e101
Transgender. e101
Transsexual. e101
Intersex. e102
Genderqueer. e102
Relationship Terms. e102
Obsolete Terms. e102
Sensitively Raising the Topic of Sexuality and Gender Identification e103
Issues of Intersectionality, Loss, and Violence for Patients From the LGBT Community e105
Intersectionality e105
Potential Issues of Loss in the LGBT Community e108
Violence and Hate Crimes e110
Part 4: Cultural Disconnects – How to Prevent Them Before They Occur, Recognize Them as They Occur, and Transform Them Once They Occur e111
Before the Interview Begins: The Look Inward e111
Core Definitions Related to Prejudice e113
Traditional Prejudice. e113
Induced Prejudice. e113
Incorporated Prejudice. e113
Dominant Cultures: Emerging Theoretical Nuances and Clinical Implications e114
Telescoping Prejudice e114
Towards a More Sophisticated Understanding of Power Differentials e115
Uncovering Potential Prejudice Within Ourselves e115
Clinician Prejudice: Reflections in a Mirror e115
A Psychodynamic Mirror e119
Transforming Moments of Cultural Disconnection e119
Six-Step Transformation of Cultural Disconnects e122
Transforming Cultural Disconnects: Interviewing Illustrations e122
Interviewing Illustration e124
Interviewing Illustration e127
A Note on Working With Interpreters e132
Part 5: Practical Tips for Exploring Religion, Spirituality, and Framework for Meaning e135
Distinctions Between Religion, Spirituality, and Worldview e138
The Clinical Value of Exploring Spirituality e140
1. Spiritual and religious explorations can improve engagement, enhancing the development of a therapeutic third culture. e140
2. An understanding of the patient’s spirituality or, perhaps in a more overarching fashion, his or her worldview can increase a patient’s interest in utilizing medication or psychotherapy. e141
3. At times patients may have a specific religious proscription against using medications and/or a specific form of psychotherapy. e141
4. Although a patient may not have immediate spiritual opposition to a specific treatment recommendation, on an unconscious level the moral codes and values by which the patient was raised may still be active or hesitancies being voiced on the web or other popular cultural media may be active, resulting in concerns regarding a specific treatment. e142
5. Spiritual crises can precipitate psychiatric symptoms. e142
6. Spiritual explorations may uncover rigid and damaging beliefs. e142
7. Spiritual explorations may uncover rich arenas for psychological growth and support. e143
8. An exploration of a patient’s framework for meaning may help to instill resiliency and hope. e143
9. An understanding of a patient’s worldview can provide critical information regarding suicide risk. e143
10. Spiritual explorations may help short-circuit cultural/spiritual practices that could interfere or disrupt the healing process. e143
Handling Countertransference Regarding Spirituality and Worldview e144
Self-Disclosure Regarding Spirituality: Uses and Cautions e145
A Caveat on Self-Disclosure Pertaining to Cultural Diversity e145
Should a Clinician Self-Disclose Religious Affiliation in an Initial Interview? e146
What to Do if a Patient Asks, “What Is Your Religious Background?” or “Do You Believe in God?” e149
How to Sensitively Raise the Topics of Spirituality, God, and Goddess e151
Indirect Methods for Raising the Topic of Spirituality e152
Griffith and Griffith’s Three Indirect Strategies e152
1. Sometimes patients will spontaneously use words, sometimes as points of emphasis (or even as a point of jest), that indirectly suggest a religious heritage. e152
2. Sometimes patients may betray significant current religious issues and/or past concerns by showing a shift in affect when mentioning a religious issue in passing. e152
3. If a patient brings up a religious or spiritual parable or metaphor that is common to a particular religion and/or spiritual tradition of which the interviewer has cultural awareness (cultural literacy), one can use this as a gateway for further exploration. e152
Indirect Exploration via Existential Questions e153
Direct Methods for Raising the Topic of Spirituality e154
Conclusion and Final Clinical Illustration e155
References e156
21 Vantage Points e161
Exploration of the Attentional Vantage Points e165
Looking at the Patient e165
Looking With the Patient e165
Somatic Empathy e166
Deep and Surface Structure e167
Counterprojective Statements e169
Looking at Oneself e173
Looking Within Oneself e175
Intuitive Reactive Responses e176
Associational Responses e178
Transferential Responses e178
Fantasy e179
Exploration of the Conceptual Vantage Points e181
Assessment for Psychodynamic Psychotherapy e181
Recognizing the Developmental Level of the Patient’s Defense Mechanisms and Sense of Self e182
Gauging Therapy-Facilitative Characteristics e183
Using Interpretive Questions to Test for Psychodynamic Readiness e186
Structural Interviewing of Kernberg e188
Illustration 1 e191
Illustration 2 e192
Illustration 3 e193
Intuitive Vantage Point e194
References e198
22 Motivational Interviewing (MI) e201
Introduction e201
Motivational Interviewing e202
Introduction to Motivational Interviewing e202
Definition e202
Spirit of MI e203
Development of MI e203
Core Principles and Techniques of MI e205
Four Guiding Interviewing Principles e205
1. Resist the Righting Reflex e205
2. Understand and Explore the Patient’s Motivations for Change e206
3. Listen With Empathy e206
4. Empower the Patient e207
OARS: Pivotal Interviewing Techniques for Applying the Principles of MI e207
Asking Open Questions e207
Cautionary Note e208
Affirming Responses e208
Affirmations Created by the Interviewer e209
Affirmations Created by the Patient e211
Reflective Listening e212
Deconstructing “Reflective Responses” e214
Summarizing e216
The Four Processes of Motivational Interviewing e218
Process e218
Process e220
Focusing Utilized in the Opening Phase of the Interview e221
Focusing Utilized in the Closing Phase of the Interview e222
EPE: Elicit – Provide – Elicit e222
Step 1 – Eliciting Permission e222
Asking Permission e222
Exploring Prior Knowledge e223
Querying Interest e223
Step 2 – Providing Information e223
Step 3 – Eliciting Feedback on the Information Provided e223
Process e224
Ambivalence, “Change Talk,” and “Sustain Talk” e224
Discrepancy e226
Process e226
Putting It All Together: An Illustrative Dialogue e227
The Bridge to Improving Medication Interest and Use e234
References e235
23 Medication Interest Model (MIM) e239
Introduction e239
Part 1: “Nonadherence” – More Than Meets the Eye e242
Extent of the Problem e242
Nonadherence: The Nature of the Beast e243
Part 2: The MIM – Development and Roots e244
Development of the MIM e244
Roots of the MIM e246
Pulling on Clinician Wisdom e246
Pulling on the Wisdom of Educational Theory and Research on Clinical Interviewing e246
Part 3: The Spirit of the MIM e248
Collaborative Exploration: The Transformative Engine of the MIM e248
The Truth About So-Called Medication “Nonadherence” e249
In Search of a New Word e252
Part 4: The Choice Triad – The Foundation of the MIM e254
Part 5: Practical Interviewing Techniques and Strategies for Enhancing Medication Interest and Use e257
Building the Medication Alliance: Toolboxes for Collaborative Exploration e257
Section 1: Toolbox for the First Prescription e260
The Medication Passport e260
Follow-Up on Uncovering the Patient’s Medication Passport e261
The Past Prescribers Passport e262
Introducing Your Personal Approach to Using Medications to the Patient e262
Section 2: Toolboxes for the Three Steps of the Choice Triad e267
Toolbox for Step 1 of the Choice Triad e267
Wisdom From a Past Century e267
Techniques for Uncovering the Patient’s Priorities for Symptom Relief e270
What to Do When Patients Do Not Believe They Have a Mental Illness e272
The Diagnostic Passport e272
The “Heading for Common Ground” Strategy: A Practical Approach When Patient and Clinician Disagree About Diagnosis e273
Toolbox for Step 2 of the Choice Triad e276
Tying Medication Use to Achieving Positive Life Goals e276
What if the Disorder Has No Symptoms? e279
Toolbox for Step 3 of the Choice Triad e282
Where Does the Patient Weigh the Pros and Cons e284
Uncovering the Patient’s Pros and Cons on Axis e285
Opening the Door to a Medication Interest Discussion e286
Addressing the Patient’s Concerns About Dosage: An Invitation of Sorts e286
The Subtle Art of Exploring Side Effects e288
How to Present a Medication When One of the Potential Side Effects Is Death e290
Questions for Uncovering Positive Effects of Medications e291
Uncovering the Patient’s Pros and Cons on Axis e292
Techniques for Addressing Financial Costs e292
Techniques for Addressing Psychological Cost e294
The Hidden Cost: Inconvenience e294
The Tragic Cost: Disruptions in Relationships e295
The Lost Goals Cost e296
Uncovering the Patient’s Pros and Cons on Axis e296
Addressing Concerns About Personal Weakness e297
Addressing a Compelling Paradox Arising With Remission e298
Questions for Ascertaining the Patient’s Ongoing Views About Continuing Medications e299
Exploring the Choice Triad: the Importance of Sequence e300
Section 3: Specialty Toolboxes for Difficult Clinical Challenges e301
Toolbox for Assessing the Patient’s Actual Medication Practices e301
Toolbox for Assessing Cultural Influences Upon Medication Interest e303
Assessing the Influence of Other Healers e304
Uncovering Cultural Biases About Medications e306
Caveats Concerning the Use of Generics e310
Toolbox for Assessing the Impact of the Web and Other Media on Your Patient’s Medication Interest e311
Toolbox for Assessing the Impact of Friends and Family on Your Patient’s Medication Interest e312
Toolbox for Medicating an Angrily Escalating Patient Involuntarily e314
Conclusion to the Book e318
References e318
Appendix I An Introduction to the Facilic Schematic System – A Shorthand for Supervisors and Supervisees (Interactive Computer Module) e321
Background and Foundation e321
Making a Longitudinal Facilic Map: Tricks of the Trade e322
Making a Cross-Sectional Map e326
Interactive Exercises for Consolidating the Understanding and Use of Facilic Shorthand e327
Exercise e328
Directions e328
Exercise e329
Answer to Exercise e329
Discussion e329
Exercise e330
Directions e330
Exercise e331
Answer to Exercise e331
Discussion e331
Exercise e332
Directions e332
Exercise e333
Answer to Exercise e333
Discussion e333
Exercise e334
Directions e334
Exercise e335
Answer to Exercise e335
Discussion e335
Exercise e337
Directions e337
Exercise e338
Answer to Exercise e338
Discussion e338
Exercise e340
Directions e340
Exercise e341
Answer to Exercise e341
Discussion e341
Exercise e342
Directions e342
Exercise e343
Answer to Exercise e343
Discussion e343
Exercise e344
Directions e344
Exercise e345
Answer to Exercise e345
Discussion e345
Exercise e346
Directions e346
Exercise e347
Answer to Exercise e347
Discussion e347
Exercise e348
Directions e348
Exercise e349
Answer to Exercise e349
Discussion e349
Exercise e351
Directions e351
Exercise e352
Answer to Exercise e352
Discussion e352
Exercise e353
Directions e353
Exercise e354
Answer to Exercise e354
Discussion e354
References e327
Appendix II Annotated Initial Interview (Direct Transcript) e356
Annotation: e356
Start of Interview e356
Appendix III The Written Document/Electronic Health Record (EHR): Effective Strategies e396
Appendix IIIA Practical Tips for Creating a Good EHR/EMR Document e401
History of the Present Illness e401
Narrative Summary and Formulation e403
Assessment of Suicide and Violence Potential e405
Appendix IIIB Prompts and Quality Assurance Guidelines for the Written Document e408
Prompts for the Initial Clinical Assessment e408
Quality Assurance Guidelines for the Written Document e409
Appendix IIIC Sample Written Assessment e412
Initial Clinical Assessment e412
I Identification, Chief Complaint, and Reason for Referral e412
II History of the Present Illness e412
III Past Psychiatric History e413
IV History of Substance Abuse e413
V Past Social and Developmental History e413
VI Current Social History e414
VII Family History e414
VIII Medical History and Review of Systems e415
IX Mental Status Examination e415
X DSM-5 Diagnosis e416
Psychiatric Disorders (Excluding Personality Dysfunction) e416
Personality Disorders e416
Medical Disorders e416
XI Narrative Summary and Formulation e416
Appendix IIID Sample Initial Clinical Assessment Form e418
Appendix IV Supplemental Articles From the Psychiatric Clinics of North America e425
Group A: Articles for Clinicians and Trainees e425
Group B: Articles for Faculty and Interviewing Mentors e425
Glossary of Interview Supervision Terms e426
Index 795
A 795
B 799
C 801
D 805
E 810
F 813
G 814
H 815
I 816
J 822
K 822
L 822
M 823
N 827
O 828
P 829
Q 836
R 836
S 838
T 843
U 845
V 845
W 847
Y 848
Z 848